January 15, 2009 Recent News





The Connecticut Department of Public Health has disciplined Bristol Hospital for significant problems in patient care.  A patient received ten times the ordered dose of a medication.  Another patient was burned in a MRI machine and yet another patient died after being taken off a vent when the patient had not consented.  The hospital admitted no wrongs but the cases speak for themselves.  In a travesty the hospital was fined only $4000 and make changes.     

The Advisory Group has shown that hospitals are doing a poor job in their relationships with physicians in general and cardiovascular physicians in particular.  The other specialties at the bottom of the list are not major money makers for the hospital so are not as important according to the Group since they emphasize the CV area. 

The AHA put out an article in early December showing how the down economy is affecting hospitals.  People are putting off getting elective procedures due to the cost and the fear of lack of being at work.  There is also more uncompensated care as people lose their jobs.  The hospitals are having a hard time getting credit for building programs.  Gee, it sounds like the rest of us.

An interesting article in the Wall Street Journal the economy is affecting physicians as well as the hospitals and some surgeons can no longer make enough money to keep their doors open.  They are going to the locum field and being hired for short periods by hospitals to do the surgery that they couldn't do when they were in practice.  Now they have no overhead and are paid a salary at each hospital they work. Also less physicians are choosing surgery for their field of endeavor.  This is even more so than the general decrease in good people going into medicine in general.  The traveling surgeons also are not under the thumb of the hospital for taking call.  They get their negotiated time off.  Even the ACS is now seeing the writing on the wall and no longer condemns itinerant surgeons. 

A recent article states that 97% of unemployed physicians and 90% of employed physicians were paid a stipend to take call.  Other options are paying for over 3 shifts per month, paying med mal insurance, contracting with a physician group to take call, using locums.  

The Palm Beach, Florida, hospitals are not happy about paying for neurosurgical coverage.  They want the needed $1.1 million to come from not just them but from nursing homes and urgent care centers.  Now the hospitals need to ship patients for neurosurgery, hand surgery and gastroenterology to Miami for care.   Top


The People's Republic of Massachusetts is again running out of money in its quest for healthcare for all.  It has to reduce or cease programs unless it uses federal money for outside help.  They want money from a federal bailout.  I certainly hope they do not succeed in getting the money.  If they want to be a model for the country they need to stand on their own feet.  The governor wants any stimulus money to be used for Medicaid and then free up that money for other programs.  Advocates want more money not the same amount.  Don't they always?

The Boston Globe ran an expose on the conflicts of interest between the Blues and Partners Healthcare that raised healthcare costs around the Republic.  The governor is now convening a panel to investigate the arrangement, albeit 8 years too late.  The panel will only look at the cost to the state by the antitrust move, not the parties.  I hope the feds also start an investigation.

Possibly as a result of the Partners Blue Cross fiasco Tufts has now broken off negotiations with Blue Cross.  Tufts says it has lost money on Blue Cross patients and of course is not getting the same as Partners.  This will continue to affect all the player in the Republic.

As Obama takes office he is getting offers from states such as New York wanting part of the give away of money.  They want to spend it on healthcare IT projects that may or may not be necessary or work. It appears that hospitals, states and every other entity in healthcare will have their hand out for monetary largess.  It makes not a whit of difference that the systems will not speak to one another and that physicians may be forced into purchasing systems that are equivocal at best.  The wonks only want money to increase their fiefdoms.  There also seems to be the little problem of patient privacy.  Some advocates want patient consent re-put into law for healthcare operations.  This would make peer review and calling into hospitals very interesting. I can foresee micromanaging by the new federal administration.

The Institute of Medicine (IOM) has issued a report on health information technology (HIT).  The studied eight provider organizations with HIT and found they were mostly helpful for defense against lawsuits and not helpful for patient care.  Physicians had to wade through much raw data and were not helped with decision supporting applications.  There was also problems with data sharing and integration.  The organizations surveyed were U of Pittsburgh, VA Washington, HCA Tristar, Vanderbilt, Partners in Boston, Intermountain Health, UCSF, Palo Alto Medical Foundation.  

Tom Daschle in his confirmation hearing stated that HIT was woefully inadequate.  He realizes that the systems today do not talk to one another.  The systems are proprietary to each organization so no information can be shared.  There are also problems with firewalls, antiviral programs and password requirements.

The Boston Globe reported an open letter to Obama saying he should not be using the funds for IT projects.  The letter was from the top tech people of the Academy of Family Physicians.  The problem is the inter connectivity or lack thereof of the systems.  There is no national secure system that all could subscribe to.  This raised the hackles of the nerds who want tech even if it is bad tech.  They think this is better for the economy that attempting to fix the infrastructure such as roads and bridges.  It should be interesting to see who Obama listens to as he has no idea about healthcare.

The AHA is after money not only for their IT but also for construction of facilities, renovation and upgrades.  They should be considering downgrades and not upgrades.  They also want legislative changes in Medicaid outpatient money and cuts in the Medicare medical education.  I guess if you ask for enough you might get something.

As all know primary care physicians are in short supply.  If healthcare for all comes in there will be much longer waits to see a primary physician.  Canada is worried as their system is crumbling and their physicians may start to immigrate to the US.   

The CMS reported that healthcare spending went down slightly in 2007.  It went from a  6.7% increase in 2006 to 6.1% the following year.  This was still significantly more than the 4.8% overall economic growth.  The major reasons for the decrease in health spending were less Medicare admin expenses and more generic drugs.  Fee for service Medicare remained stable but Medicare HMO increased due to more people enrolling.  The biggest percentage increase was personal out of pocket expenses which went from 3.3% to 5.4% largely due to prescription drugs, nursing home services and nondurable medical supplies.   

A recent blog noted the conflicts of Uwe Reinhardt, the Princeton professor and lover of HMOs.  He stated that fee for service is not working and is recommending that physicians be paid on "evidence based case reimbursement".  He believes this would help control overall health care spending.  What he neglects to say as does the liberal media wonks is that Professor Reinhardt is not pure.  It should be noted that he is a highly paid member of the board of Amerigroup with over 130,000 shares of stock (0ver $3,800,000 and last year received an additional compensation of $118,000.  He also is on the boards of two H&Q Healthcare Investors and a trustee of Duke University.  He is also a member of the board of Boston Scientific.  Professor Reinhardt and the media do not disclose these financial relationships and how they may influence what the Professor says and does.        Top


Blue Shield has finally caved and agreed to restore coverage and offer new coverage without pre-existing conditions and pay for covered expenses for about 700 Californians whose policies were  illegally rescinded.  California, in turn, dropped its law suit against the insurer and also dropped a $12 million fine. In order to get the above the individuals have to agree not to sue Blue Shield.  Some plaintiff attorneys are not happy campers as they see money flying out the window.        Top


  DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.